*EMBARGOED All research presented at the ACG Annual Scientific Meeting is strictly embargoed until Monday, October 19, 2015 at 8 AM (EDT).
Oral 38 The Cost-Effectiveness of Competing Strategies for Managing Multiply Recurrent Clostridium difficile Infection: Examining the Impact of Universal Stool Banks and Encapsulated Fecal Microbiota Transplantation
Author Insight from Zain Kassam MD, MPH, FRCPC, OpenBiome / MIT Center for Microbiome Informatics & Therapeutics
What’s new here and important for clinicians?
Clostridium difficile is the leading healthcare-associated infection and translates to a cost of $4.8 billion per year in the United States. Fecal microbiota transplantation (FMT) is a promising therapy for recurrent Clostridium difficile infection (rCDI). Universal stool banks like OpenBiome have emerged to improve safe access to FMT, and have developed FMT capsules. However, the economic impact of these novel public health approaches is unclear.
We designed a cost decision-analysis model to compare the cost-effectiveness of 1) universal stool bank FMT, 2) directed donor (e.g. spouse, sibling) FMT, or 3) oral vancomycin taper for CDI. Results suggest the universal stool bank FMT approach was the most cost-effective strategy, showing an incremental cost-effectiveness ratio (i.e. the additional cost per additional unit of effectiveness gained) of just over $28,500 compared to vancomycin. We also examined the cost-effectiveness of four FMT delivery modalities: 1) colonoscopy, 2) capsule, 3) enema, 4) naso-enteric delivery. The results suggest FMT capsules are the most cost-effective delivery modality, dominating other treatments with an incremental direct cost savings of $3,661 relative to vancomycin. However, FMT capsules only dominate when clinical cure rates were >89.2%. Given limited efficacy data for FMT capsules, further studies including dose-finding trials are needed before widespread clinical adoption. Overall, FMT by colonoscopy remains a cost-effective treatment for rCDI with an incremental direct cost savings of $3,647 compared to vancomycin.
What do patients need to know?
C. diffficile is a terrible intestinal infection that causes diarrhea, abdominal pain and sometimes death. C. difficile is a major problem in hospitals, and costs the U.S. healthcare system close to $5 billion a year. Unlike antibiotics, fecal microbiota transplantation (FMT) are very effective at curing recurrent C. difficile, but doctors often have trouble getting safe stool. Stool banks, like OpenBiome, have come to the rescue and have helped treat over 6,000 patients in more than 400 hospitals in 5 countries. Our study shows that using a universal stool bank is the most cost-effective way of treating recurrent C. difficile. Also, FMT capsules may be the most cost-effective way of doing FMT, but more studies are needed to pick the right dose. For now, it seems FMT by colonoscopy is the most cost-effective treatment for recurrent C. difficile, with an incremental direct cost savings of $3,647 compared to standard antibiotics.
Zain Kassam MD, MPH, FRCPC, OpenBiome / MIT Center for Microbiome Informatics & Therapeutics
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